Gallstone disease in a teaching hospital, Addis Ababa: a 5-year review

There are not many studies of gallbladder disease in Africa. The disease appears to be not uncommon in Ethiopia. To determine the prevalence and evaluate the management of gallstone disease in a central teaching hospital, a 5-year retrospective study was undertaken in 747 patients surgically treated for gallbladder disease in the period 1995-99 in Tikur Anbessa Hospital, Addis Ababa. The sex ratio (M:F) was 1:5, narrower ratio in complicated cholelithiasis. The mean age was 42 years. About 80% of patients were in the age group between 30 and 60 years. The median duration of symptoms at admission was 2 years. Abdominal pain, in 96% of cases situated in the right upper quadrant (RUQ) and usually aching type, was the most frequent presenting symptom; RUQ tenderness was the most common sign. Clinically, 29.4% of patients were categorized obese. Gallstone detection rate by ultrasound was about 96% but cholecystitis appeared to be overlooked. At operation, about 77% of cases had features of chronic cholecystitis, 2% acalculous cholecystitis. Majority of the stones were grossly cholesterol stones. Cholecystectomy was performed in 99% of cases, most often through the oblique subcostal and transverse routes. The overall in-hospital mortality rate was 0.4%. Nearly 87% of cases had postoperative course without incident. The etiologic factors and the type of gallstones, we believe, are not different from that of the developed world. Cholecystectomy is a safe and most effective procedure that provides ultimate cure for symptomatic gallstone disease.